PROJECT SUMMARY/ABSTRACT There is a rising burden of type 2 diabetes and associated risk factors among children, disproportionately affecting low-income and minority communities. Addressing lifestyle-associated risk factors is an integral component of type 2 diabetes prevention. To be most effective, efforts targeting children require caregiver engagement and a family-oriented approach. Notably, adult caregivers could also benefit from a family- oriented approach to promote health behavior change. To date, however, there have been few sustainable or widespread efforts to develop family-oriented diabetes prevention programs that have multi-generational impacts. Dr. Venkataramani is an internist and pediatrician who aspires to lead rigorous research efforts to address this need for family-oriented diabetes prevention efforts among low-income children and adults. She seeks to build upon her research fellowship training and unique clinical background by acquiring additional research skills and expertise required to achieve her long-term career goal. This Mentored Patient-Oriented Research Career Development (K23) Award will provide her with the opportunity to: 1) develop expertise in qualitative methods (to inform intervention design and evaluation); 2) develop skills in intervention design and development; 3) acquire skills in the design and conduct of clinical trials; 4) develop an understanding of the principles of implementation science; and 5) engage in additional career development activities to enable her transition to independence as a clinician-investigator. In this K23 application, Dr. Venkataramani proposes to develop and pilot a family-oriented adaptation (FDPP) of the National Diabetes Prevention Program?s (DPP) adult lifestyle intervention that will include supplementary, child-related programming. Her proposal leverages the Johns Hopkins Brancati Center?s existing infrastructure and expertise in National DPP lifestyle change program delivery to low-income communities in Baltimore (efforts led by her co-primary mentor Dr. Nisa Maruthur). Specifically, she proposes to: 1) develop the FDPP, informed by low-income caregivers? preferences for program content and structure; 2) pilot the FDPP among low-income caregivers and their children in Baltimore in a pilot randomized controlled trial with a National DPP comparator group; and 3) further refine the FDPP by qualitatively evaluating participant and coach experiences in the program. This work, and subsequent R01 studies, has the potential to advance the field of diabetes prevention by developing a lifestyle intervention with multi-generational impact. Dr. Venkataramani?s research will occur in a supportive, collaborative environment at Johns Hopkins, under the guidance of a dedicated team of faculty mentors, led by Dr. Tina Cheng, MD, MPH and Dr. Nisa Maruthur MD, MHS. This multidisciplinary team engages faculty across internal medicine, pediatrics and public health who are committed to ensuring that she will be well equipped for a highly productive career as an independent clinician-investigator who advances type 2 diabetes prevention efforts for low-income adults and children.